RICHARD L. MABRY, MD
Copyright 2018, Richard L. Mabry
AUTHOR’S NOTES:
When I got the editorial letter for my first novel, I couldn’t believe it needed improvement. The publisher had bought the book, so why did I need to rewrite it? I’ve found since that time, in the decade and more that I’ve been writing professionally, that a novel can always be improved. This one is no exception, and I thank my first reader, Kay Mabry for suggesting to me how to do it. The novel has been rewritten, following her recommendations, and is the better for it.
As is the case with all my indie-published work, my thanks go to Dineen Miller for designing and executing a great cover, Barbara Scott for applying her editorial genius, and Virginia Smith for getting this book into print.
I appreciate all the writers who, over the years, have unselfishly mentored and supported me along this road to writing. There are too many to name, but you know who you are.
Over a decade ago, when I set out to write a book about my struggles after the death of my first wife, a book that was published as The Tender Scar, I had no idea that God would lead me along this path of writing. I’ve been fortunate enough now to see the publication of twelve novels and four novellas, in addition to the non-fiction book I originally set out to craft. I’m amazed and a bit awe-struck by all this. But, as always, Soli Deo Gloria—to God be the glory.
CONTENTS
GUARDED PROGNOSIS
CHAPTER 2
CHAPTER 3
CHAPTER 4
CHAPTER 5
CHAPTER 6
CHAPTER 7
CHAPTER 8
CHAPTER 9
CHAPTER 10
CHAPTER 11
CHAPTER 12
CHAPTER 13
CHAPTER 14
CHAPTER 15
CHAPTER 16
CHAPTER 17
CHAPTER 18
CHAPTER 19
CHAPTER 20
CHAPTER 21
CHAPTER 22
CHAPTER 23
WATCH FOR MY NEXT NOVELLA, EMERGENCY CASE, RELEASING THIS WINTER
WHAT OTHERS HAVE SAID ABOUT RICHARD MABRY’S BOOKS
GUARDED PROGNOSIS
The men sitting in adjacent chairs looked out of place in the corner of the surgeon’s waiting room. It wasn’t just that they didn’t have visible bandages, or that neither of them winced or evidenced pain. While many of the men and women waiting to see Dr. Caden Taggart bore expressions that said they either needed the surgeon’s attention or had already experienced it, these two men presented themselves the way drug salesmen do—sitting patiently, idly thumbing through magazines, almost bored.
When he came to the front desk to hand off the chart of the patient he’d just seen, Caden glanced at the men in the corner. He noted they wore dark suits and white shirts. Their conservative ties were snugged against their cleanly shaven necks, and their lace-up shoes had probably been shined this morning. He didn’t know who they were—perhaps police, maybe FBI—but their presence in his office worried him. He didn’t think he had anything to fear, but then again . . .
Caden leaned closer to his receptionist. “Donna, who are those two men?”
“I didn’t get their names. They flashed ID and badges but stowed them before I got a good look. They said they had to see you. When I asked them why, they said they’d discuss it with you.”
“They didn’t give you any clue?”
She lowered her voice even further, although no one seemed to be paying attention to the conversation. “They wouldn’t say anything beyond what I’ve told you. They took a seat, and that’s where they’ve been since then.”
“When’s my next patient?”
“In ten minutes. She’s post-op appendectomy and arrived a bit early. Ruth just took her back to do vital signs.”
“Why don’t I see them while I’m waiting? Give me a moment, then send them back.”
As he entered his office, Caden glanced at the cherrywood desk his father had given him when he opened his surgical practice two years ago. He wondered if Dr. Henry Taggart ever considered that there were more important gifts he could share with his son than those bought with money.
Caden’s thoughts were interrupted by the arrival of the two strangers. “Gentlemen.” He inclined his head toward the two chairs across the desk from him. He decided not to say anything more for fear he might indicate the nervousness he felt. Let them talk.
As he sat down behind the desk, Cade took the measure of his visitors. The man on his left was probably in his late 50s. His dark hair was cut short and showed a hint of gray at the temples. The other man, about a decade younger than the first, was blond. Other than that, they were very much alike—average build, no facial hair, clothes neat but not flashy.
The older man pulled out a small leather wallet and held it out to Caden, who noted the badge and ID card it contained. “I’m agent Darren Neilson, Drug Enforcement Agency.” He nodded toward the man on his left. “This is agent Jerry Harwell.”
Harwell offered his badge and credentials but said nothing.
Caden looked at the ID cards. They carried the names the two men had given, the pictures matched the facial features he saw across the desk, and the badges said Drug Enforcement Agency. Of course, he’d never seen real badges or credentials from the agency. He had no idea of the authenticity of their credentials. He decided that, for now, he’d accept the identities the men across the desk presented.
Caden took a deep breath and waited for them to explain their presence. The practice of medicine had so many regulations now, he wondered which one of them he’d inadvertently broken. He was certain he’d filled out all the forms, paid all the required fees, instituted the necessary safeguards. As a general surgeon, he sometimes prescribed narcotics, but not a lot, and always with no refills. What could the DEA want with him?
Neilson pulled a piece of paper from an inner coat pocket. Evidently, he was going to be the spokesman for the two. “Do you remember a patient named John Pace?” He didn’t wait for Caden to respond before he went on. “Emilia Smith? Bart Wilkerson? Ed Cowgill?”
“I see lots of people. Sometimes I operate on them. Then, with few exceptions, they go back to their referring doctor. I don’t really have any long-term relationships with my patients. But, no, none of those names strikes a chord with me.”
The older agent laid the list on the desk and pulled out another one, which he only glanced at. “The maximum prescription for Vicodin and similar narcotics is eight a day for a month, or 240 tabs. Pace and Smith got a script from you recently for that amount.”
Caden guessed he’d heard those numbers before, but they weren’t applicable to his practice, so he’d ignored them. “I don’t—”
Neilson talked right over him. “For patients with breakthrough pain, you can give an additional 120 tabs. That’s what Wilkerson and Cowgill got, also in a prescription signed by you.”
Caden was shaking his head before the agent finished. “This has to be a mistake. I don’t think I’ve ever written such a script.”
Just then there was a tap on the door and Caden’s nurse stuck her head in. “Doctor, your patient is ready in treatment room one.”
“Please tell the patient I’ll be another few minutes, Rose.” He waited until she withdrew and the door was closed before he addressed the two men across the desk from him. “Was my signature on those prescriptions? Was my DEA number used?”
Rather than answer Caden’s question, Agent Harwell drew an official-looking document from inside his coat, unfolded it, and held it out for the doctor to read. “This is a death certificate for a patient. Look at the cause of death.”
Caden leaned forward. The line in question read, “C
ardiac and respiratory arrest due to drug administration.” He read it twice before looking at Harwell. “This is unfortunate, but what does it have to do with me?”
Harwell returned the death certificate to his pocket. “Fentanyl, usually as a patch, is sometimes given for severe pain. But the latest thing for drug addicts is graduating to a mixture of heroin and fentanyl. This man, and more like him, died after using such a combination. And the fentanyl was obtained using your name and DEA number.”
“Whoa! I’m certain that I’ve never written a prescription for fentanyl in any form.”
“Are you sure? Did you ever give someone else authorization to use your name and number? Under any circumstance?”
The doctor recalled hearing that an innocent man has nothing to fear from the law. That might be true in theory, but right now he felt anything but secure. “Do I need a lawyer?”
Neilson took up the conversation now. His tone was that of a favorite uncle, trying to reassure a worrying nephew. “You can call your attorney if you think you need to. But if you’re innocent . . . ”
Who would I call? I don’t know a lawyer. Certainly not one I trust in a situation like this.
Before Caden could speak, the agent went on. “If you cooperate we can keep this simple. On the other hand, if you want to complicate things . . . ”
The doctor felt his pulse climbing while his throat seemed to close up. No, I don’t want to complicate things. If I don’t call a lawyer, if I cooperate, maybe they’ll go away, and this will all be over.
“I guess we’ll keep this simple. What do you need from me?”
Caden was a full hour behind schedule when he got around to seeing patients again. Although he was pretty good at compartmentalizing problems and devoting his undivided attention to the situation at hand, in the back of his mind he kept going over his conversation with the two men.
They’d be back for more in a few days. Apparently, they planned to check records, procedures, everything about the practice. They gave no indication that Caden was involved in the illegal prescribing, but the men stopped short of assuring him he was innocent. Should he consult an attorney? Again, he didn’t know one to call. And what would he tell them if he did? No, he decided to go with Neilson’s suggestion. Keep things simple. After all, he was innocent.
Noontime came and went, but eventually the waiting room was empty. “Do I have a break here?” he asked his nurse, Rose.
She looked at her watch. “About three quarters of an hour before your next patient. I’m going to run up to the corner deli. Want me to bring you a sandwich?”
“No, I’m not particularly hungry,” Caden said.
“Oh, Dr. Taggart.” Donna approached from the front desk, a pink call slip in her hand. “This message came in about an hour ago. I was going to interrupt you, but the caller said to give it to you at your next break. It wasn’t urgent. And you’d know the number.”
He took the piece of paper she handed him. It said, “Call Dr. Henry Taggart at his office.” So far as Caden was concerned, when his father took time from his own surgical practice to call, the urgency was implied. Although he called Caden at home occasionally, he couldn’t remember a call from his father to his office since he’d opened his practice.
“I’ll phone him now,” Caden said, and turned away.
He dropped into the swivel chair behind his desk, pulling the phone toward him and trying to suppress his apprehension. His father had said that his son knew his dad’s office number. Actually, that wasn’t true. He tried to remember when he’d last called that number, but he couldn’t. Caden found the number in his middle desk drawer on one of his father’s cards. With a silent prayer, he punched in the numbers.
“Dr. Taggart’s office.”
“Hi Jean,” he said. “This is Caden Taggart. My dad called me. Is he with a patient?”
“He’s just finishing. Can you hold for a minute? I know he wants to talk with you.”
There was nothing particularly unusual in Jean’s words, but nevertheless something sounded . . . different. He couldn’t put his finger on it, but it definitely set off his radar.
It wasn’t long before Dr. Henry Taggart picked up the phone. “Caden. Thanks for calling back.”
Caden started with the question that jumped to the mind of most children when they receive a phone call from an older parent. “Dad, is everything okay? Has something happened to you or mom?”
“So far as I know, your mother is fine. I visited the nursing home this past weekend. The staff is taking good care of her, and her doctor checks on her periodically.” He paused. “I’m afraid I’m the one who has a little problem.”
The sinking feeling Caden experienced was like the one he got in a glass elevator that went down too rapidly. For Henry Taggart to admit he had a problem—even a “little one”—wasn’t good.
“I’ve been having some vague digestive symptoms,” the elder Taggart said. “It went on long enough that I finally checked with my internist. He poked and prodded, then persuaded me to have a GI series. After I—”
“Dad, tell me what Dr. Geist found.”
“He thinks it’s most likely pancreatic carcinoma.”
Caden felt acid rise in the back of his throat. His pulse sounded like a windstorm in his ears. Pancreatic carcinoma. To a doctor, this translated into a virtual death sentence. The diagnosis was almost never made in time to do anything more than give palliative or experimental treatment. The son in Caden wanted to drop everything and rush to his father’s side. The physician, on the other hand, began to think through the various treatment options and the medical personnel and places that administered them.
“Fred wants me to see the oncologists at the university medical center here in Dallas,” Henry said. “They’ve got a good team of specialists over there, and I’m sure they’re ready to jump in—if I let them.”
“What do you mean ‘if’? Aren’t you planning to let the doctors handle this?”
“Possibly,” Henry said. “But we both know that if this is pancreatic cancer, the outlook is pretty grim.”
“But it’s not—”
Before Caden could finish his sentence, his father added, “And I may need your help.”
“I’ll do anything I can to help, but there are good people at the medical center there. Do you want me to come to Dallas? Would you like me—”
“No, I don’t want you to treat me. I want you to help me if I decide to commit suicide.”
2
The smell coming from the oven brought a smile to Beth’s face. She was glad she’d learned to cook . . . although not from her mother’s teaching. No, the best thing her mother made for dinner was reservations. After she was married, Beth had read books, watched TV programs, and exchanged tips with other wives as Caden completed his residency. Her cooking may have started out as suspect, but by now she was sure her husband had no complaints about the food she set before him.
Beth felt something brush against her ankles. She looked down at the tan kitten and smiled. “Sorry, Kitty. No time to play. Caden will be home soon.” She heard the door open and close. “There he is now.”
When her husband came through the door into the kitchen, Beth dried her hands on the apron she wore. She turned to look at him, and when she saw his expression her heart fell. “I’m guessing something really bad happened today.”
She turned back toward the stove, but Caden caught her from behind in a hug that lasted longer than usual. He kissed the nape of her neck. “You don’t know the half of it.”
“Well, I will when you tell me about it.” She put down the spoon she had picked up and gave her husband a proper kiss. “Supper needs about twenty more minutes in the oven. Let’s go into the living room so you can unload.”
Beth was used to Caden’s tales of the day’s adventures. Actually, she enjoyed the second-hand exposure to the medical world. She wished she was back working as a nurse, but that wasn’t what Caden wanted. When they moved to Freeman, h
e’d told her he wanted her to be a stay-at-home wife . . . and mother.
As they headed for the sofa, the place they usually sat and shared stories of the day, Beth could tell Caden seemed lost in thought. She eased down in her usual place, patted the cushion beside her, and said, “Tell me about it.”
“I talked with Dad today.”
Beth’s eyebrows shot up. “Did he come by?”
“No, he called.”
Since Henry Taggart’s calls to his son were about as frequent as a lunar eclipse, Beth knew something unusual was going on. She didn’t realize how unusual until Caden finished his recital of what his father had told him.
“Carcinoma of the pancreas?” She tried to keep from showing the fear every medical professional felt when they heard those words. “But it’s still presumptive, based on an exam and one set of X-rays. He hasn’t had confirmation of the diagnosis yet. Right?”
“Right, but both his internist and he seemed pretty sure.”
“Until it’s more than a suspected diagnosis, there’s still hope,” Beth said. “And even if it does turn out to be pancreatic carcinoma, we don’t know what Henry’s clinical course will be.”
True, the diagnosis mentioned was oftentimes a death sentence, but Beth, as a trained nurse, also knew that it was utter foolishness to say that a person had such-and-such a number of weeks or months to live. Predictions like that were never made in medicine, despite the way the movies and novels showed doctors issuing such exact pronouncements.
“His internist wants him to see some specialists at the medical center there in Dallas,” Caden said. “We should know more about it soon. He mainly called to tell me about the diagnosis.”
“How’s he taking it?”
“Hard to tell, but what he asked me sort of gave me a clue.” Caden paused, as though getting up his courage for the next sentence. “He asked me about helping him commit suicide.”
Beth felt like someone had sucker-punched her in the gut. If the diagnosis was correct, she realized that the outcome didn’t look good, but it was far from set in stone. Finally, she spoke. “What did you tell him?”
Guarded Prognosis Page 1